We, the Catholic bishops of Iowa, are grateful that the governor and the Iowa Legislature are debating how to make health care coverage more readily available to low-income Iowans.

The Catholic Church has millennia of experience as providers of health care for all, especially the poor. Among the causes that contribute to poverty are “inadequate measures for guaranteeing basic health care” (Compendium of the Social Doctrine of the Church, 447). It is in this spirit we reiterate our Catholic tradition that teaches that health care is a natural human right, essential to protecting human life and dignity.

We believe there are several criteria that should be considered when evaluating a health care proposal. It should 1) ensure access to quality, readily accessible, affordable, life giving health care for all; 2) retain longstanding requirements that federal funds not be used for elective abortions or plans that include them, and effectively protect conscience rights; and 3) protect the access to health care that immigrants currently have and remove current barriers to access.

Ultimately it is the role of our civil leaders to decide what is most practical in achieving the common good. Currently the Medicaid public health insurance program is limited to very low-income adults who have dependents or a disability. One of the decisions facing the Legislature is whether to extend Medicaid with the assistance of additional federal dollars.

The proposed "Medicaid expansion" passed by the Iowa Senate would:

extend coverage to almost all people who earn less than 138 percent of the federal poverty level – projected to include 150,000 persons in Iowa;

persons whose income is from 138-400 percent of FPL could purchase private plans with the assistance of tax credits through an “exchange” (marketplace);

if a person qualifies for the program by reason of income, they are entitled to care

there are no monthly premiums;

it would cost the state’s budget less money during the next several years due to the federal government paying a greater share of the expenses.

A Healthy Iowa plan passed by the Iowa House would:

extend coverage to those who earn less than 100 percent of the FPL – about 90,000 people;

persons whose income is from 100-400 FPL could purchase private insurance plans with the assistance of tax credits through the exchange;

enrollment and benefits may be limited, closed or reduced if costs exceed appropriated funds;

premiums would be required and recipients can be dropped from the program if they don’t pay;

the plan requires a waiver from the federal government.

Both plans would cover refugees and lawful permanent residents in the same way as Medicaid. Unfortunately, neither corrects a certain problem contained in the federal Affordable Care Act - the subsidization of health insurance plans in the exchange that include coverage of elective abortion. We call on the legislature to exclude these plans from the exchange.

With about a quarter-million Iowans lacking health care coverage, this issue remains an urgent priority. We call upon our political leaders to set aside partisan concerns and consider this issue with prudence and a commitment to the common good. Especially since the current limited IowaCare program is expiring, action by the General Assembly and the governor is critical to make sure that as many people as possible have access to life-sustaining health insurance.